Family Presence During Resuscitation Efforts

Family presence during resuscitation efforts continues to be a controversial issue among healthcare providers. The purpose of this paper is to explore advantages and disadvantages to this concept from the healthcare provider and family's perspective, and address the patient's viewpoint. A personal insight and ethical considerations are included. Sources of information consist of literature reviews of the topic, and databases were utilized using the key words "family presence,""witnessed cardiopulmonary resuscitation," and "family presence during resuscitation efforts." The information provided will demonstrate that family presence during resuscitation efforts is a necessary and ethical standard in healthcare practices today and can help nurses feel more comfortable facilitating this process.     

The Effect of Family Presence During Resuscitation and Invasive Procedures on Patients and Families: An Umbrella Review

IntroductionThe concept of family presence during resuscitation and invasive procedures is a controversial issue and has not been universally adopted by health care providers. Owing to the sheer number of studies in this field, we conducted this umbrella study to provide an overview of this concept with the aim of investigating the impact of family presence on patients, families, and resuscitation and invasive procedures.MethodsIn this review, using the Joanna Briggs Institute levels of evidence umbrella methodology guidelines, the authors searched PubMed, Google Scholar, Embase, MEDLINE, Web of Science, Scopus, and the Cochrane database for systematic review and meta-analysis studies that evaluated the presence of family during resuscitation and invasive procedures without time limit until July 2020. The following key words were used for the search: family presence; family witness; parent presence; parent witness; and resuscitation.ResultsA total of 254 articles published between January 1967 and July 2020 were screened. Five articles (1 meta-analysis and 4 systematic reviews) met the inclusion criteria. The review showed that family presence during resuscitation or invasive procedures does not have negative effects on family members, patients, or the resuscitation or invasive intervention process. Family members focus on the patients, not the ongoing treatment. The presence of family members is beneficial for both family members and health care staff. None of the reviewed studies reported a negative effect on family members.DiscussionThe presence of parents and other immediate family members during resuscitation and invasive procedures has positive impacts on patients, families, and health care staff.     

Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria,Australia

IntroductionFamily Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR.MethodsOne rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study.ResultsSeventeen adult presentations (Metro n = 9, Rural n = 8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication.ConclusionDuring 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education.     

Report of the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures.

Representatives from 18 national organizations were convened for a conference to develop recommendations regarding family presence (FP) during pediatric procedures and cardiopulmonary resuscitation. Before the conference, invitees were given a questionnaire and provided with current literature regarding FP. A modified Delphi process was used to develop consensus, including use of multiple questionnaires and breakouts for discussion of specific issues. Participants were encouraged to develop consensus recommendations based on the literature and discussions. Changes in attitude were tracked with repeat questionnaires. Results of the conference were circulated to participants for review and revision. Consensus recommendations include (1) consider FP as an option for families during pediatric procedures and cardiopulmonary resuscitation, (2) offer FP as an option after assessing factors that could adversely affect the interaction, (3) if family is not offered the option for FP, document the reasons why, (4) always consider the safety of the health care team, (5) develop in-hospital transport and transfer policies and procedures for FP, such as family member definition, preparation of the family, handling disagreements, and providing support for the staff, (6) obtain legal review of policies, (7) include education in FP in all core curricula and orientation for health care providers, (8) promote research into best methods for education; effects of FP on patients, family, and staff; best practices for FP; and legal issues regarding FP, among others. These recommendations were approved in concept by the American Academy of Pediatrics and the Ambulatory Pediatrics Association.     

Practice Alert: Family Presence During CPR and Invasive Procedures

Families are asking to be with their loved ones during emergency procedures and resuscitation. The family is a valuable component of the health care team. They ultimately have the most stake in the patient's survival and outcomes. Families expect the health care team to do the best job possible and place a great deal of trust in them and the decisions made. Health care teams control the situation during CPR and approve or deny the presence of the family. Families are in crisis and require support and reassurance to cope. Adherence to ENA's protocols strengthens that trust in the team and the patient-family bond. Isn't this what radiology professionals want in their practice?     

Interprofessional Teams: Lessons Learned From a Nurse-Led Clinic

Interprofessional teams positively affect the quadruple aim of improving patient experience, improving the health of populations, enhancing provider satisfaction, and reducing cost. This report details a nurse-led care model developed for a complex patient population in Archer, Florida. The practice, Archer Family Health Care, is a Rural Health Clinic providing integrated primary care and mental health services. The team model included nursing, medicine, and pharmacy professionals and expanded care for case management and mental health. Evaluation included team functionality and clinical outcome data for selected populations. This report describes lessons learned during the implementation process and provides recommendations for the future.     

Development of a University-based Emergency Department Network: Lessons Learned

Background

As part of the growth of emergency medical care in our state, our university-based emergency medicine practice developed a network of affiliated emergency department (ED) practices. The original practices were academic and based on a faculty practice model; more recent network development incorporated a community practice model less focused on academics.

Objective

This article discusses the growth of that network, with a focus on the recent addition of a county-wide two-hospital emergency medicine practice. During the transition of the two EDs from a contract management group to the university network, six critical areas in need of restructuring were identified: 1) departmental leadership, 2) recruitment and retention of clinical staff members, 3) staffing strategies, 4) relationships with key constituents, 5) clinical operations, supplies, and equipment, and 6) compensation structure. The impact of changes was measured by comparison of core measures, efficiency metrics, patient volumes, admissions, and transfers to the academic medical center before and after the implementation of our practice model.

Conclusion

Our review and modification of these components significantly improved the quality and efficiency of care at the community hospital system. The consistent presence of board certified emergency physicians optimized utilization of clinical resources in the community hospital and the academic health system. This dynamic led to a mutually beneficial merger of these major state healthcare systems.